<!DOCTYPE html>
<html>
<head>
	<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
	<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
	<title>Checkout example · Bootstrap</title>
	<link href="https://cdn.bootcss.com/twitter-bootstrap/4.3.1/css/bootstrap.min.css" rel="stylesheet">
	<link href="css/common.css" rel="stylesheet">
	<link href="css/form-validation.css" rel="stylesheet">
</head>
<body class="bg-light">
<div class="container">
	<div class="py-5 text-center">
		<img class="d-block mx-auto mb-4" src="css/bootstrap-solid.svg" alt="" width="72" height="72">
		<h2>Checkout form</h2>
		<p class="lead">Below is an example form built entirely with Bootstrap’s form controls. Each required form group has a validation state that can be triggered by attempting to submit the form without completing it.</p>
	</div>
	<div class="row">
		<div class="col-md-4 order-md-2 mb-4">
			<h4 class="d-flex justify-content-between align-items-center mb-3">
				<span class="text-muted">Your cart</span>
				<span class="badge badge-secondary badge-pill">3</span>
			</h4>
			<ul class="list-group mb-3">
				<li class="list-group-item d-flex justify-content-between lh-condensed">
					<div>
						<h6 class="my-0">Product name</h6>
						<small class="text-muted">Brief description</small>
					</div>
					<span class="text-muted">$12</span>
				</li>
				<li class="list-group-item d-flex justify-content-between lh-condensed">
					<div>
						<h6 class="my-0">Second product</h6>
						<small class="text-muted">Brief description</small>
					</div>
					<span class="text-muted">$8</span>
				</li>
				<li class="list-group-item d-flex justify-content-between lh-condensed">
					<div>
						<h6 class="my-0">Third item</h6>
						<small class="text-muted">Brief description</small>
					</div>
					<span class="text-muted">$5</span>
				</li>
				<li class="list-group-item d-flex justify-content-between bg-light">
					<div class="text-success">
						<h6 class="my-0">Promo code</h6>
						<small>EXAMPLECODE</small>
					</div>
					<span class="text-success">-$5</span>
				</li>
				<li class="list-group-item d-flex justify-content-between">
					<span>Total (USD)</span>
					<strong>$20</strong>
				</li>
			</ul>
			<form class="card p-2">
				<div class="input-group">
					<input type="text" class="form-control" placeholder="Promo code">
					<div class="input-group-append">
						<button type="submit" class="btn btn-secondary">Redeem</button>
					</div>
				</div>
			</form>
		</div>
		<div class="col-md-8 order-md-1">
			<h4 class="mb-3">Billing address</h4>
			<form class="needs-validation" novalidate="">
				<div class="row">
					<div class="col-md-6 mb-3">
						<label for="firstName">First name</label>
						<input type="text" class="form-control" id="firstName" placeholder="" value="" required="">
						<div class="invalid-feedback">
							Valid first name is required.
						</div>
					</div>
					<div class="col-md-6 mb-3">
						<label for="lastName">Last name</label>
						<input type="text" class="form-control" id="lastName" placeholder="" value="" required="">
						<div class="invalid-feedback">
							Valid last name is required.
						</div>
					</div>
				</div>
				<div class="mb-3">
					<label for="username">Username</label>
					<div class="input-group">
						<div class="input-group-prepend">
							<span class="input-group-text">@</span>
						</div>
						<input type="text" class="form-control" id="username" placeholder="Username" required="">
						<div class="invalid-feedback" style="width: 100%;">
							Your username is required.
						</div>
					</div>
				</div>
				<div class="mb-3">
					<label for="email">Email <span class="text-muted">(Optional)</span></label>
					<input type="email" class="form-control" id="email" placeholder="you@example.com">
					<div class="invalid-feedback">
						Please enter a valid email address for shipping updates.
					</div>
				</div>
				<div class="mb-3">
					<label for="address">Address</label>
					<input type="text" class="form-control" id="address" placeholder="1234 Main St" required="">
					<div class="invalid-feedback">
						Please enter your shipping address.
					</div>
				</div>
				<div class="mb-3">
					<label for="address2">Address 2 <span class="text-muted">(Optional)</span></label>
					<input type="text" class="form-control" id="address2" placeholder="Apartment or suite">
				</div>
				<div class="row">
					<div class="col-md-5 mb-3">
						<label for="country">Country</label>
						<select class="custom-select d-block w-100" id="country" required="">
							<option value="">Choose...</option>
							<option>United States</option>
						</select>
						<div class="invalid-feedback">
							Please select a valid country.
						</div>
					</div>
					<div class="col-md-4 mb-3">
						<label for="state">State</label>
						<select class="custom-select d-block w-100" id="state" required="">
							<option value="">Choose...</option>
							<option>California</option>
						</select>
						<div class="invalid-feedback">
							Please provide a valid state.
						</div>
					</div>
					<div class="col-md-3 mb-3">
						<label for="zip">Zip</label>
						<input type="text" class="form-control" id="zip" placeholder="" required="">
						<div class="invalid-feedback">
							Zip code required.
						</div>
					</div>
				</div>
				<hr class="mb-4">
				<div class="custom-control custom-checkbox">
					<input type="checkbox" class="custom-control-input" id="same-address">
					<label class="custom-control-label" for="same-address">Shipping address is the same as my billing address</label>
				</div>
				<div class="custom-control custom-checkbox">
					<input type="checkbox" class="custom-control-input" id="save-info">
					<label class="custom-control-label" for="save-info">Save this information for next time</label>
				</div>
				<hr class="mb-4">
				<h4 class="mb-3">Payment</h4>
				<div class="d-block my-3">
					<div class="custom-control custom-radio">
						<input id="credit" name="paymentMethod" type="radio" class="custom-control-input" checked="" required="">
						<label class="custom-control-label" for="credit">Credit card</label>
					</div>
					<div class="custom-control custom-radio">
						<input id="debit" name="paymentMethod" type="radio" class="custom-control-input" required="">
						<label class="custom-control-label" for="debit">Debit card</label>
					</div>
					<div class="custom-control custom-radio">
						<input id="paypal" name="paymentMethod" type="radio" class="custom-control-input" required="">
						<label class="custom-control-label" for="paypal">PayPal</label>
					</div>
				</div>
				<div class="row">
					<div class="col-md-6 mb-3">
						<label for="cc-name">Name on card</label>
						<input type="text" class="form-control" id="cc-name" placeholder="" required="">
						<small class="text-muted">Full name as displayed on card</small>
						<div class="invalid-feedback">
							Name on card is required
						</div>
					</div>
					<div class="col-md-6 mb-3">
						<label for="cc-number">Credit card number</label>
						<input type="text" class="form-control" id="cc-number" placeholder="" required="">
						<div class="invalid-feedback">
							Credit card number is required
						</div>
					</div>
				</div>
				<div class="row">
					<div class="col-md-3 mb-3">
						<label for="cc-expiration">Expiration</label>
						<input type="text" class="form-control" id="cc-expiration" placeholder="" required="">
						<div class="invalid-feedback">
							Expiration date required
						</div>
					</div>
					<div class="col-md-3 mb-3">
						<label for="cc-cvv">CVV</label>
						<input type="text" class="form-control" id="cc-cvv" placeholder="" required="">
						<div class="invalid-feedback">
							Security code required
						</div>
					</div>
				</div>
				<hr class="mb-4">
				<button class="btn btn-primary btn-lg btn-block" type="submit">Continue to checkout</button>
			</form>
		</div>
	</div>
	<footer class="my-5 pt-5 text-muted text-center text-small">
		<p class="mb-1">© 2019 <a href="https://github.com/T5750">T5750</a></p>
		<ul class="list-inline">
			<li class="list-inline-item"><a href="#">Privacy</a></li>
			<li class="list-inline-item"><a href="#">Terms</a></li>
			<li class="list-inline-item"><a href="#">Support</a></li>
		</ul>
	</footer>
</div>
<script src="https://cdn.bootcss.com/jquery/3.3.1/jquery.slim.min.js"></script>
<script src="https://cdn.bootcss.com/twitter-bootstrap/4.3.1/js/bootstrap.bundle.min.js"></script>
</body></html>